<!DOCTYPE html>
<html>
	<head>
		<meta charset="utf-8">
		<meta name="viewport" content="width=device-width, initial-scale=1.0, user-scalable=no"/>
		<title>美年大健康</title>
		<link href="css/mn.css" rel="stylesheet" />		
		<link rel="stylesheet" href="css/font-awesome.min.css" />
	</head>
	<body class="bg1">
		
		<h2 class="h2">预约体检</h2>
		
		<section class="reservation-form">
			<form name="reservation" action="/" method="post">
				<ul>
					<li class="clear">
						<div class="reservation-form-name">选择城市</div>
						<div class="reservation-form-value">
							<div class="selectWraper">
							<input type="hidden" name="city" />
							<span class="select-value">杭州</span> <i class="icon-chevron-down"></i> 
							<ul class="select-option">
								<li data-value="天津">天津</li>
								<li data-value="上海">上海</li> 
								<li data-value="北京">北京</li> 
								<li data-value="杭州">杭州</li>
							</ul>
							</div>
						</div>
					</li>
					<li class="clear">
						<div class="reservation-form-name">预约体检点</div>
						<div class="reservation-form-value">
							<div class="selectWraper">
							<input type="hidden" />
							<span class="select-value">延安路分院</span> <i class="icon-chevron-down"></i> 
							<ul class="select-option">
								<li data-value="南京西路">南京西路</li>
								<li data-value="延安路分院">延安路分院</li>
								<li data-value="东平路">东平路</li>
							</ul>
							</div>
						</div>
					</li>
					<li class="clear">
						<div class="reservation-form-name">预约日期</div>
						<div class="reservation-form-value">
							<input type="text" class="input calendar-input" />
							<i class="icon-calendar"></i>
						</div>
					</li>
					<li class="clear">
						<div class="reservation-form-name">姓名</div>
						<div class="reservation-form-value"><input type="text" class="input" /></div>
					</li>
					<li class="clear">
						<div class="reservation-form-name">性别</div>
						<div class="reservation-form-value">
							<div class="selectWraper">
							<input type="hidden" />
							<span class="select-value">男</span> <i class="icon-chevron-down"></i> 
							<ul class="select-option">
								<li data-value="男">男</li>
								<li data-value="女">女</li>								
							</ul>
							</div>
						</div>
					</li>
					<li class="clear">
						<div class="reservation-form-name">身份证</div>
						<div class="reservation-form-value"><input type="text" class="input" /></div>
					</li>
					<li class="clear">
						<div class="reservation-form-name">联系电话</div>
						<div class="reservation-form-value"><input type="text" class="input" /></div>
					</li>
				</ul>
				<div class="reservation-form-submit"><a href="javascript:submit();" class="btn-red"><i class="icon-stethoscope"></i> 预约体检</a></div>
			</form>
		</section>
		
		<section class="foot fix-bottom"><a href="tel:400-689-0688" class="white-color"><i class="icon-phone"></i> 400-689-0688</a></section>
		
				
		<script type="text/javascript" src="js/zepto.min.js" ></script>
		<script type="text/javascript" src="js/fastclick.js"></script>
		<script type="text/javascript" src="js/mn.js"></script>
	</body>
</html>
